Reducing the Incidence of Postoperative Nausea and Vomiting Using a Predictor Scale

Abstract

Problem: Postoperative nausea and vomiting (PONV) are reported as the most common adverse effects of general anesthesia in a suburban community hospital's post-anesthesia care unit (PACU). A monthly analysis of clinical data shows that 55-65% of patients experience PONV after receiving general anesthesia. This number is significantly higher than the national rate of 30-35%. Purpose: This quality improvement (QI) project aimed to implement and evaluate a PONV screening, risk stratification, and recommended practice guideline for use with adult patients undergoing general anesthesia. Methods: During this QI project, a four-item, yes/no Apfel screening tool was integrated into the electronic health record (EHR). Patients who scored positive, Apfel score of three and four, received prophylactic treatments based on the Anesthesia & Analgesia (A&A) Fourth Consensus Guidelines recommendation for managing PONV. Results: Among 2,340 eligible adult surgical patients, 877 (37.5%) screened positive for PONV, with Apfel scores of three and four. Of these high-risk patients, 715 (81.5%) received prophylactic treatment per A&A guideline recommendation, with 136 (19%) requiring postoperative antiemetics. The total percentage of PONV decreased to below 20% per month, representing over 40% reduction from the baseline. Conclusions: Screening surgical adult patients for PONV using the validated Apfel scoring tool and providing prophylactic treatments per patient's risk score can reduce the incidence of PONV and decrease the need for administering rescue antiemetic agents postoperatively.